Provider First Line Business Practice Location Address:
4004 S VERMONT AVE
Provider Second Line Business Practice Location Address:
STE #6
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-232-6686
Provider Business Practice Location Address Fax Number:
323-232-6626
Provider Enumeration Date:
12/29/2005